The new age of play audiometry: prospective

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Transcript of The new age of play audiometry: prospective

The new age of play audiometry: iPad-based playaudiometerIntroductionPure tone audiometry in childrenPure-tone audiometry, regardless of automation is a mundane task. It is especially challenging to perform in the pediatric population where short attention span and the extent of cognitive development can be limiting factors. Children with hearing impairmentmay find audiometric testing even more difficult.BackgroundDefinitive diagnosis of hearing loss is typically made through audiologic assessment of pure-tone air, boneand speech thresholds. Traditionally, pure-tone thresholdsare documented by asking the subject if they can hear tones of varying frequency and intensity. While auditory brainstem reflex and otoacoustic emissions testing remain the gold standard of hearing assessment, these investigations pose some difficulty in children.StatisticsOur data suggests that using the tablet interactive audiometry method, the majority (82%, 70/85) of childrenas young as 3 years of age are capable of understanding the concept of the game and completing thehearing assessment. In fact, 4 of the 15 patients were unable to complete the assessment due to a technical issue related to the audiologist. Despite the supervision of an audiologist however, some children had difficulties with the tabletaudiometer. These difficulties resulted from technical deficiencies of the hardware/software (i.e. attempts toopen other software, failure to understand ‘drag and drop’, becoming distracted by visual re-enforcements) andbehaviors of the patient (i.e. boredom, poor comprehension of the game). A number of these difficulties eventually lead to the subject being excluded from the statistical analysis. Failure to complete the assessment also appeared to be more prevalent in children with abnormal hearing.It is not surprising then that portable tablet computers have been widely embraced in healthcare and education. Thus, the tablet operating system appears to the optimal environment in which to develop portable, automated diagnostic applications targeted at children.The timely diagnosis of hearing loss in the pediatric population has significant implications for a child’sdevelopment.

However, audiological evaluation in this population poses unique challenges due to difficulties withpatient cooperation. The existing technology is time consuming and costly.The objective of this study is to validate an iPad-based play audiometer thataddresses the shortcomings of existing audiometry.Techniques to make this possible include :Behavioral observation Visual re-enforcementConditioned play audiometry. Resource utilisation Require two specially trained audiologists to administer. Naturally, anideal solution would capitalize on the advantages ofautomation, while maintaining clinical validity and ageappropriateness.Solution?? The purpose of this study is to(1) determine the accuracy of audiometric thresholds obtained by tablet audiometry compared to the accepted standard, conditioned play audiometry in children; and (2) describe our experiences with administering an iPad-based hearing assessment in the pediatric population.

Interactive audiometry is a novel paradigm in the assessment of hearing thresholds, in which the patient controls the presentation and pace of sound stimuli, rather than the audiologist.

The tablet play audiometer is engineered as a decision-tree interactive game (yes/noparadigm) or as a two alternative forced choice interaction.

The two-alternative forced choice test paradigmis a psychophysical method for eliciting responsesfrom a person about his or her experiences of a stimulus whereby the user is only given two possible responses..Tablet AudiometerIn this “game”, the child is only given one container and is tasked to drag the object into this container when it produces a sound. Each sound producing object plays a unique warble-tone at either 500, 1000, 2000 or 4000 Hz.The intensity of sound decreases with each presentation until the child is unable to reproduciblysort the objects.Subsequently, the intensity of the sounds is increased.Once all frequenciesare tested, a standard audiogram is obtained.The GAMEConclusionThe goal of the research is to develop a portable, versatile clinical audiometer designed for children. This study is the first to validate an automated play audiometer designed specifically for the pediatric population.The device has a strong predictive value for normalhearing and is highly sensitive for hearing loss. Finally, our results demonstrated that the tablet audiometer is a viable platform for testing children as young as 3 years of age.Future ScopeFuture directions will focus on gameplay refinementand test-retest reliability.Thank you!! ;)